Information Collection

Mentor Feedback Survey

IC 229864 under ICR 201710-0990-002 · OMB 0990-0463.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
ICDI Mentor Program Feedback.docx	Other-feedback
ICDI Mentor Program Feedback_Clean.docx	Other-MENTOR FEEDBACK

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-feedback			ICDI Mentor Program Feedback.docx		Yes	Yes	Fillable Printable
Other-MENTOR FEEDBACK			ICDI Mentor Program Feedback_Clean.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 700

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	700	700
Annual IC Time Burden (Hours)	93	93
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.